Eating out can be dangerous when a diner has food allergies

More than 12 million Americans – about 4 percent of the population – suffer from food allergies. Here are some tips for eating safely in restaurants.

Kathryn Rem

More than 12 million Americans – about 4 percent of the population – suffer from food allergies. A true food allergy is an immune-system response to a food that the body mistakenly believes is harmful. Here are some tips for eating safely in restaurants.

Eating in a restaurant is a minefield for Bethany Jaeger.

Shellfish, dairy, nuts, beans, wheat, soy and corn all make her sick, so the Chatham, Ill., woman has to avoid commonly used ingredients that include marinades, sauces, breading, grains and butter.

"If I can get a meal that's tasty and doesn't turn my stomach, I'm a return customer," said Jaeger, 30, a management consultant for Kerber, Eck & Braeckel.

More than 12 million Americans -- about 4 percent of the population -- suffer from food allergies. A true food allergy is an immune-system response to a food that the body mistakenly believes is harmful.

Millions of Americans also have food intolerances, which bring about reactions in the digestive tract, not the immune system. With an intolerance -- lactose is the most common one -- the body lacks the mechanism or enzyme needed to digest and properly process a particular food.

Sensitivities to foods are a growing public health concern, according to the Fairfax, Va.-based Food Allergy & Anaphylaxis Network (www.foodallergy.org), and so are the challenges faced by diners with food allergies and intolerances when they eat in restaurants.

It wasn't until last May that Lisa Loyd of Rushville, Ill., got a diagnosis of celiac disease.

According to the National Institutes of Health, celiac is an immune reaction to gluten, a protein found in wheat, rye and barley. An estimated 1 percent of Americans suffer from the disease, although many have never been diagnosed and are not receiving treatment.

"I grew up in Beardstown, home of the fish fry," said Loyd, 42, a billing specialist at Memorial Medical Center. "I had this my whole life. I just thought it was normal."

"When I learned what it was, I was terrified to go out to eat. But I've done a lot of research and know what to avoid now. When you find servers willing to take the time to help, you tip very well."

Even with diligence, however, problems occur.

Loyd ordered french fries at a fast-food restaurant not long ago. In with the regular fries were a few errant curly fries that had been coated with seasoning. She was ill within 30 minutes, most likely due to the seasoning.

Dr. Marsha Woodruff of Springfield, Ill., is sensitive to monosodium glutamate (MSG) and other flavor enhancers. For her, they trigger migraine headaches.

"I have been reading (restaurant food) labels for 15 years and thought I was protecting myself, but there are many other additives that aren't called MSG.

"The restaurants say they don't have MSG in the food, but they have other things, so I order and end up sick," said Woodruff, a dentist.

A concern for restaurants

Like most eateries, Cracker Barrel Old Country Store strives to work with diners who have food allergies.

A request for comment at the Springfield store was forwarded to the chain's corporate office in Lebanon, Tenn. Julie K. Davis, Cracker Barrel corporate communications senior director, e-mailed a statement, which read:

"Our food safety training provides managers with food alternatives that can be shared with guests who are allergic to foods, including milk and eggs. We also commonly check ingredient labels for guests who describe a specific food allergen, and will take extra precautions when preparing meals for guests who have shared food allergen concerns with us."

Chris Weiss, vice president of advocacy and government relations for the Food Allergy & Anaphylaxis Network, predicts governments will become more involved in how restaurants deal with food allergens.

"We're probably at the beginning stages of a legislative movement," he said, citing the enactment last year in Massachusetts of a law requiring restaurants in that state to post allergy-related information for diners and staff and to provide food-allergy training for managers.

"Once it passes in one state, we're probably going to see other states implement similar laws," he said.

Weiss' organization, which is working with Massachusetts to develop rules and regulations for the new Food Allergy Awareness Act, has been tracking deaths due to food allergies for 10 years. He said about half of the deaths were caused by foods consumed in restaurants.

Advice for diners

Often, Jaeger settles for a simple restaurant meal.

"More often than not, I ask for a plain chicken breast not brushed with corn oil, a baked potato not soaked in oil and steamed vegetables. But I've found a few restaurants that are really good about working with me," she said.

"I often call in advance and tell them I have food allergies and have eaten there before and I ask if they can be flexible." She sticks with locally owned restaurants, because chain restaurants often use foods that can't be altered and aren't made from scratch, such as salad dressings and marinades.

"Sometimes it helps to tell them what I can have, instead of what I can't. I'll say I can have meat cooked with olive oil, rice, any vegetable with olive oil and fresh herbs," Jaeger said.

She says the plain food she normally settles for when dining out can be boring.

"But I'm more interested in not getting sick than in the taste," she said.

Loyd, who has celiac disease, also is wary of fast-food restaurants because of the high chance of cross-contamination.

"If they fry the french fries in the same oil they fried the chicken nuggets, I'll get sick," she said.

Loyd recommends these sites on the Web: www.celiac.com, www.glutenfreefaces.com and www.glutenfreeregistry.com for solid information and recommendations on eating establishments.

She looks for restaurants that have gluten-free menus.

Loyd typically asks her server if there is an allergy-free menu. If not, she asks to speak to the manager or kitchen manager.

"I ask a lot of questions. Sometimes if beef isn't hand-cut, it can be processed with a marinade. A lot of items have thickeners in them. I want to know if the tortillas are flour or corn."

Loyd avoids buffets. There are just too many unknowns in the dishes.

"It's so nice to find a restaurant that will work with me and take the time to answer my questions. It makes me feel like a normal person instead of a genetic freak."

When a server approaches Woodruff, who avoids MSG, in a restaurant, "I tell them I have food issues. I say, 'I need to know if you have MSG in your food.' Sometimes they come back and say it's in this or that. Sometimes they say they don't use it at all."

Woodruff estimated restaurant staffs are helpful about 75 percent of the time.

"I'm hyper-vigilant. But even so, there are so many times I come home and a migraine happens four to six hours later.

"Eating is such a social thing. You want to participate. But you just never know. You can be waylaid by garlic bread with a seasoning on it."

Kathryn Rem can be reached at 217-788-1520.

Chef cards

The Food Allergy & Anaphylaxis Network suggests diners with allergies make up "chef cards" to hand to their restaurant servers. Sample:

To the chef:

WARNING! I am allergic to ___________. In order to avoid a life-threatening reaction, I must avoid all foods that might contain ___________, including these ingredients:_________.

Please ensure that my food does not contain any of these ingredients and that all utensils and equipment used to prepare my meal, as well as prep surfaces, are thoroughly cleaned prior to use. Thanks for your cooperation.

Allergies at a glance

The U.S. Food and Drug Administration says 90 percent of all food-allergy reactions are caused by: